Umbilical metastasis from ovarian carcinoma: Sister Mary Joseph's nodule

Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imagıng in Pseudo Sister Mary Joseph's Nodule

Sister Mary Joseph's nodule (SMJN) refers to umbilical metastatic lesions and indicates widespread intra-abdominal malignancy. The most common primary sites are gastrointestinal and genital tract. Benign umbilical nodules are called pseudo-SMJN (PSMJN) and have been also reported in nonmalignant lesions such as endometriosis, fibroma, papillomas, myxoma, keloid, omphalith, nevi, foreign-body granulomas, and epidermoid cysts. We report a case with PSMJN as an extremely rare manifestation of intra-abdominal tuberculosis.

Cutaneous Metastases in Ovarian Cancer

Skin metastases in ovarian cancer are uncommon, but their incidence may be increasing due to improved survival rates. Skin metastases can be divided into umbilical metastases, which are known as Sister Joseph nodules (SJNs) and are associated with peritoneal metastasis, and non-SJN skin metastases, which usually develop within surgical scars and in the vicinity of superficial lymphadenopathy. As most skin metastases develop after specific conditions, recognition of preceding metastatic diseases and prior treatments is necessary for early diagnosis of skin lesions. The prognosis of skin metastases in ovarian cancer varies widely since they are heterogeneous in the site of lesion and the time of appearance. Patients with SJNs at initial diagnosis and patients with surgical scar recurrences without concomitant metastases may have prolonged survival with a combination of surgery and chemotherapy. In patients who developed skin recurrences as a late manifestation, symptoms should be treated with external beam radiotherapy and immune response modifiers. Immune checkpoint blockade can enhance anti-tumor immunity and induce durable clinical responses in multiple tumor types, including advanced chemoresistant ovarian cancer. With the use of radiation therapy, which enhances the systemic anti-tumor immune response, immune checkpoint blockade may be a promising therapeutic strategy for distant metastasis, including skin metastasis.

Skin metastases in epithelial ovarian and fallopian tube carcinoma

This study aimed to investigate the clinical features and outcomes of skin metastasis in ovarian and fallopian tube carcinomas.We studied patients with epithelial ovarian or fallopian tube carcinoma who developed skin metastasis from 2001 through 2012, and were also treated with chemotherapy and/or surgery.Skin metastases were classified as umbilical metastasis (Sister Joseph nodule [SJN]) and nonumbilical metastasis. Patients who developed skin metastases at paracentesis sites were excluded.Of the 206 patients treated, 12 (5.8%) developed skin metastasis: 7 developed SJN, and 5 developed nonumbilical metastasis. Six patients had serous carcinoma, 3 had clear cell carcinoma, 2 had endometrioid carcinoma, and 1 had adenocarcinoma. Four patients out of the 7 who developed SJN had skin metastasis at initial diagnosis, and all 4 patients had SJN with concomitant peritoneal dissemination. Of the 4 patients, 3 received chemotherapy, and their survival ranged from 22 to 42 months. Of the 7 patients who developed SJN, 3 patients with stage IIIC disease developed an SJN at recurrence and were treated with surgery and/or chemotherapy. Their survival duration after recurrence ranged from 26 to 43+ months. Five patients developed nonumbilical metastases 3 to 53 months (median 34 months) after initial diagnosis: 3 cases occurred in incisional scars of primary surgery, and 2 in subcutaneous metastasis in the other sites. Survival after recurrence ranged from 56 to 140+ months in 3 patients with incisional scar recurrence, and it was 5 months in 2 other patients.Sister Joseph nodule developed only in patients with peritoneal dissemination, and most patients with SJN survived for >24 months. Nonumbilical metastases occurring in incisional scars of primary surgery may carry a favorable prognosis.

Cholangicarcinoma Presenting as a Sister Mary Joseph Nodule

Sister Mary Joseph nodules represent metastatic cancer of the umbilicus. More than half of these cases are attributable to gastrointestinal malignancies including gastric, colonic, and pancreatic cancer. In addition, gynecologic (ovarian, uterine cancer), unknown primary tumors, and, rarely, bladder or respiratory malignancies may cause umbilical metastasis. We report the case of a Sister Mary Joseph nodule originating from a hilar cholangiocarcinoma. Umbilical nodules should prompt clinical evaluation, as these tumors are usually associated with poor prognosis.

Sister Mary Joseph's nodule at a University teaching hospital in northwestern Tanzania: a retrospective review of 34 cases

BACKGROUND

Sister Mary Joseph's nodule is a metastatic tumor deposit in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. There is a paucity of published data on this subject in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients, and to proffer solutions for improved outcome.

METHODS

This was a retrospective study of histologically confirmed cases of Sister Mary Joseph's nodule seen at Bugando Medical Centre between March 2003 and February 2013. Data collected were analyzed using descriptive statistics.

RESULTS

A total of 34 patients were enrolled in the study. Males outnumbered females by a ratio of 1.4:1. The vast majority of patients (70.6%) presented with large umbilical nodule > 2 cm in size. The stomach (41.1%) was the most common location of the primary tumor. Adenocarcinoma (88.2%) was the most frequent histopathological type. Most of the primary tumors (52.9%) were poorly differentiated. As the disease was advanced and metastatic in all patients, only palliative therapy was offered. Out of 34 patients, 11 patients died in the hospital giving a mortality rate of 32.4%. Patients were followed up for 24 months. At the end of the follow-up period, 14(60.9%) patients were lost to follow-up and the remaining 9 (39.1%) patients died. Patients survived for a median period of 28 weeks (range, 2 to 64 weeks). The nodule recurred in 6 (26.1%) patients after complete excision.

CONCLUSION

Sister Mary Joseph's nodule of the umbilicus is not rare in our environment and often represents manifestation of a variety of advanced intra-abdominal malignancies. The majority of the patients present at a late stage and many with distant metastases. The patient's survival is very short leading to a poor outcome. Early detection of primary cancer at an early stage may improve the prognosis.

A review of the cutaneous paraneoplastic associations and metastatic presentations of ovarian carcinoma

Ovarian carcinoma possesses cutaneous and paraneoplastic associations. The aim of this study was to review the paraneoplastic associations and metastatic presentations of ovarian carcinoma. PubMed was searched through December 2006 for references to cutaneous metastatic ovarian carcinoma (CMOC). CMOC occurs in 2-7% of cases, manifests in advanced disease and indicates a poor prognosis. The paraneoplastic associations of ovarian carcinoma include acanthosis nigricans, Raynaud's phenomenon, scleroderma, dermatomyositis and palmar fasciitis with polyarthritis. Dermatomyositis, in particular, can precede the diagnosis of ovarian carcinoma. Ovarian carcinoma has many cutaneous paraneoplastic effects and metastatic presentations, all of which portend a poor prognosis. Dermatomyositis is sometimes the initial manifestation of ovarian cancer, thus women > 40 years of age with dermatomyositis should be checked for ovarian carcinoma. It is possible that paraneoplastic dermtomyosititis can be distinguished from nonparaneoplastic dermatomyostitis by the former's lack of (i) associated Raynaud's phenomenon, (ii) response to treatment, (iii) autoantibodies, (iv) overlap and association with other collagen vascular diseases and (v) the presence of the prodromal symptoms of ovarian carcinoma such as gastrointestinal symptoms, urinary symptoms and/or fatigue or malaise.

Stage IV epithelial ovarian carcinoma in an 18 year old patient presenting with a Sister Mary Joseph's nodule and metastasis in both breasts: a case report and review of the literature

BACKGROUND

The most frequent ovarian malignancy in mature women is of epithelial origin. In children and adolescents, it is very rare, and in such cases it mostly concerns tumors of low malignant potential or low stage I tumors.

CASE

We describe an 18-year-old girl presenting with umbilical metastasis as a first sign of an extremely aggressive stage IV ovarian serous papillary adenocarcinoma without an objective response to chemotherapy and endocrine therapy. She developed metastasis in both breasts and died 28 months after the initial diagnosis.

CONCLUSION

This is the first case of a stage IV epithelial ovarian cancer under the age of 20 years. Furthermore, uncommon breast metastasis and a Sister Mary Joseph's nodule have never been described at such young age.

Sister Joseph's nodule in a liver transplant recipient: Case report and mini-review of literature

BACKGROUND: Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph's nodule. CASE PRESENTATION: A 59-years-old Caucasian female underwent liver transplant for end stage liver disease due to hepatitis C with whole graft from cadaveric donor in 2003. After transplantation the patient developed multiple subcutaneous nodules in the umbilical region and bilateral inguinal lymphadenopathy. The excision biopsy of the umbilical mass showed the features of a poorly differentiated papillary serous cystadenocarcinoma. Computed tomographic scan and transvaginal ultrasonography were unable to demonstrate any primary lesion. Chemotherapy was start and the dosage of the immunosuppressive drugs was reduced. To date the patient is doing well and liver function is normal. CONCLUSIONS: The umbilical metastasis can arise from many sites. In some cases, primary tumor may be not identified; nonetheless chemotherapy must be administrated based on patient's history, anatomical and histological findings.